Optimization of nonresponders to left bundle branch area pacing using electrical dyssynchrony mapping.
- 1Minneapolis Heart Institute East, Allina Health, St. Paul, Minnesota.
- 2University of Minnesota, Minneapolis, Minnesota.
- 3Heart Rhythm Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota.
Abstract
Background
Left bundle branch area pacing (LBBAP) is a new approach to resynchronization in patients with heart failure (HF). Treatment of LBBAP nonresponders by optimizing programming has not been studied.Objective
This study aimed to assess the effects of optimization on left ventricular (LV) size and systolic function in LBBAP nonresponders.Methods
We studied 41 patients with systolic HF and attempted LBBAP 6.5 ± 4.3 months post-implantation. Nonresponders (pre-cardiac resynchronization therapy [CRT] ejection fraction [EF] < 45% and increase in EF < 5%) and incomplete responders (increase in EF > 5% but final EF < 45%) to LBBAP were included. Electrical dyssynchrony was assessed using a novel measure called cardiac resynchronization index (CRI). Patients with R waves in V1 were classified as left bundle branch pacing (LBBP) and those without R waves in V1 as deep septal pacing. Patients were programmed to optimal atrioventricular delay, ventricular-ventricular delay, and pacing mode (LBBAP-only, biventricular, or LV-only). Echocardiograms before CRT, before optimization, and 8.2 ± 4.4 months after optimization were read in blinded fashion.Results
Most patients had LV leads (90.2%). LBBP was present in 41.5% and deep septal pacing in 58.5% of patients. CRI increased from 59.8% ± 25.9% to 84.5% ± 16.7%. CRT optimization significantly improved LV EF from 34.0% ± 7.0% to 37.0% ± 6.4% (P < .0001), end-systolic volume from 83.1 ± 38.9 to 72.7 ± 35.5 mL (P < .001), end-diastolic volume from 124.9 ± 46.3 to 112.9 ± 46.8 mL (P < .001), and global longitudinal strain from -10.5 ± 3.2 to -11.5 ± 3.0 (P = .01).Conclusion
CRT programming to optimal CRI significantly improves LV systolic function, end-systolic volume, end-diastolic volume, and global longitudinal strain in nonresponders and incomplete responders to LBBAP, offering a non-invasive, practical clinical approach to improving response in patients having LBBAP.
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BibTeX
@article{bank2026optimization,
title = {{Optimization of nonresponders to left bundle branch area pacing using electrical dyssynchrony mapping.}},
author = {Alan J Bank and Fernando E Santiago and Kevin V Burns and Grace E Hegland and Jason Cook and Edriss Charaf},
journal = {Heart rhythm O2},
year = {2026},
month = jul,
doi = {10.1016/j.hroo.2026.06.026},
url = {https://europepmc.org/article/MED/42936037},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Optimization of nonresponders to left bundle branch area pacing using electrical dyssynchrony mapping.
AU - Alan J Bank
AU - Fernando E Santiago
AU - Kevin V Burns
AU - Grace E Hegland
AU - Jason Cook
AU - Edriss Charaf
PY - 2026
DA - 2026/07/09
JO - Heart rhythm O2
DO - 10.1016/j.hroo.2026.06.026
UR - https://europepmc.org/article/MED/42936037
AB - Background Left bundle branch area pacing (LBBAP) is a new approach to resynchronization in patients with heart failure (HF). Treatment of LBBAP nonresponders by optimizing programming has not been studied.Objective This study aimed to assess the effects of optimization on left ventricular (LV) size and systolic function in LBBAP nonresponders.Methods We studied 41 patients with systolic HF and attempted LBBAP 6.5 ± 4.3 months post-implantation. Nonresponders (pre-cardiac resynchronization therapy [CRT] ejection fraction [EF] < 45% and increase in EF < 5%) and incomplete responders (increase in EF > 5% but final EF < 45%) to LBBAP were included. Electrical dyssynchrony was assessed using a novel measure called cardiac resynchronization index (CRI). Patients with R waves in V1 were classified as left bundle branch pacing (LBBP) and those without R waves in V1 as deep septal pacing. Patients were programmed to optimal atrioventricular delay, ventricular-ventricular delay, and pacing mode (LBBAP-only, biventricular, or LV-only). Echocardiograms before CRT, before optimization, and 8.2 ± 4.4 months after optimization were read in blinded fashion.Results Most patients had LV leads (90.2%). LBBP was present in 41.5% and deep septal pacing in 58.5% of patients. CRI increased from 59.8% ± 25.9% to 84.5% ± 16.7%. CRT optimization significantly improved LV EF from 34.0% ± 7.0% to 37.0% ± 6.4% (P < .0001), end-systolic volume from 83.1 ± 38.9 to 72.7 ± 35.5 mL (P < .001), end-diastolic volume from 124.9 ± 46.3 to 112.9 ± 46.8 mL (P < .001), and global longitudinal strain from -10.5 ± 3.2 to -11.5 ± 3.0 (P = .01).Conclusion CRT programming to optimal CRI significantly improves LV systolic function, end-systolic volume, end-diastolic volume, and global longitudinal strain in nonresponders and incomplete responders to LBBAP, offering a non-invasive, practical clinical approach to improving response in patients having LBBAP.
SN - 2666-5018
ER -